Utilization of Dental Services in the Adolescent Population of Chiapas, Mexico

To analyze the association between the coverage by oral health teams in the Family Health Strategy (FHS-OH) and the use of dental services among 12-year-old adolescents in the state of Mato Grosso do Sul, Brazil, 2019. This is a cross-sectional study involving school-based research, which adopted the use of dental services as its outcome. Structural equation modeling was used to test the association between covariates and the outcome. Of the 615 participants, 74.0% used dental services in the last three years. ESF-SB (oral health coverage by family health strategy, acronym in Portuguese) ≥50% was associated with a greater use of public dental services [standardized coefficient (SC) = 0.10 -95%CI 0.01;0.18], a lower use of these services for prevention (SC = -0.07 -95%CI -0.17;0.01) and higher unhealthy food consumption (SC = 0.19 -95%CI 0.11;0.26). Higher ESF-SB coverage was associated with a lower use of dental services for prevention and higher unhealthy food consumption. Teams must organize the access to oral health service and qualify the work process.

BackgroundAccess to, and use of, dental health services in Brazil have improved since 2003. The increase of private health care plans and the implementation of the “Smiling Brazil” Program, the largest public oral health care program in the world, could have influenced this increase in access. However, we do not yet know if inequalities in the use of dental health services persist after the improvement in access. The aims of this study are to analyze socioeconomic differences for dental health service use between 2003 and 2008 in São Paulo and to examine changes in these associations since the implementation of the Smiling Brazil program in 2003.MethodData was obtained via two household health surveys (ISA-Capital 2003 and ISA-Capital 2008) which investigated living conditions, lifestyle, health status and use of health care services. Logistic regression was used to analyze associations between socioeconomic factors and dental services use. Additionally, trends from 2003 to 2008 regarding socioeconomic characteristics and dental health service use were explored.ResultsOverall, dental health service use increased between 2003 and 2008 and was at both time points more common among those who had higher income, better education, better housing conditions, private health care plans and were Caucasian. Inequalities in use of dental health care did not decrease over time. Among the reasons for not seeking dental care, not having teeth and financial difficulty were more common in lower socioeconomic groups, while thinking it was unnecessary was more common in higher socioeconomic groups.ConclusionsThe Brazilian oral health policy is still in a period of expansion and seems to have contributed slightly to increased dental health service use, but has not influenced socioeconomic inequalities in the use of these services. Acquiring deeper knowledge about inequalities in dental health service use will contribute to better understanding of potential barriers to reducing them.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1928-y) contains supplementary material, which is available to authorized users.

Rural riverside populations of Brazil face several difficulties to access health services. The Brazilian National Primary Care Policy implemented the Fluvial Family Health Teams (FFHT), which is a specific primary care team arrangement for these territories. The aim of the study was to assess the use of dental services by adults living in rural riverside areas covered by a FFHT. A household-based cross-sectional survey was carried out with a rural riverside population of 38 localities on the left bank of the Rio Negro, Manaus, Amazonas, representative of the area covered by the FFHT. Stratified random sampling was calculated based on the number of adults and households in each riverside locality. An electronic questionnaire was used to obtain information on sociodemographic and oral health conditions, and the utilization of dental services. After descriptive analysis, logistic regression analyses were performed to estimate the odds ratios for the outcome 'use of dental health services over the past 12 months'. A total of 492 individuals, aged 18 years or more, from 38 rural riverside areas were assessed. The mean age of participants was 43.5 years (standard deviation 17.0), ranging from 18.0 to 90.7 years. Of these participants, 3.1% had never been to a dentist and 21.9% had been to a dentist more than 3 years ago. Among those who attended the dental service, 77.4% of appointments occurred in public health services. Dental pain over the previous 6 months (odds ratio (OR)=2.44; 95% confidence interval (CI) 1.51-3.96), higher education (OR=2.62; 95%CI 1.23-5.56), most recent appointment in public health services (OR=1.86; 95%CI 1.19-2.93), edentulism (OR=0.38; 95%CI 0.17-0.85) and dissatisfaction with oral health (OR=0.59; 95%CI 0.38-0.93) were associated with the dental services utilization. The study results revealed that approximately a quarter of the individuals did not use dental services over the previous 3 years or have never used them. Despite the increase in access provided by the FFHT, edentulous individuals, individuals dissatisfied with their oral health, and those with lower levels of education were less likely to use dental services, while individuals who experienced dental pain sought dental services more frequently. These findings suggest that the healthcare model offered to this population must be rearranged.

BackgroundLack of use of dental services can be a risk factor for oral health. In addition to recent visits to dental services, it is important to assess the regularity of use of these services, as well as the motivations for visiting the dentist. There is a gap in literature studies on the patterns of use of oral health services by the young university students. The goal of this study was to assess the factors associated with recent and regular non-use of dental services by young university students, using the Andersen model as a reference.MethodsThis was a cross-sectional study with 477 university students between 18 and 24 years old, carried out as a web survey, through which predisposing, enabling and need variables were collected, according to the model proposed by Andersen, to test the factors associated with recent and regular non-use of dental services. Bivariate analyses and robust Poisson regression were performed, with estimation of crude and adjusted prevalence ratios, using confidence intervals of 95%. The variables with p < 0.05 remained in the final model.ResultsThe prevalence of recent non-use was of 19.5% (95% CI 16.0–23.3%), and of regular non-use, of 53.5% (95% CI 48.9–58.0%). After the adjusted analysis, the following were found to be associated with the outcome of recent non-use: type of service used (PR = 0.91; 95% CI 0.85–0.98) and perceived need for dental treatment (PR = 0.98; 95% CI 0.97–0.99); and the following variables were associated with regular non-use: father’s level of education (PR = 0.86; 95% CI 0.78–0.96), area of study (PR = 1.08; 95% CI 1.02–1.15), reason for last dental appointment (PR = 0.81; 95% CI 0.75–0.88), use of dental services throughout childhood (PR = 0.92; 95% CI 0.86–0.97), self-perceived oral health (PR = 0.86; 95% CI 0.76–0.88), and toothaches over the last 2 years (PR = 0.93; 95% CI 0.87–0.99).ConclusionThe motivation for young university students to use dental services are curative treatment needs, not prevention. The results point to the need to implement health prevention and promotion policies in higher education institutions and to expand access to dental services for this young population.

BackgroundSocioeconomic status and oral health care habits may change throughout adult life. This calls for age-stratified analyses of oral health in the adult population to uncover differences that could be of importance for organizing adequate oral health care services. The aim of the present study was to describe self-reported oral health in different age groups in a general adult population in Norway, and to explore associations between self-reported oral health and age groups, sociodemographic factors, use of dental services, number of teeth and dental caries.MethodsWe used data from a cross-sectional study of almost 2000 Norwegian adults, 20–79 years old. The study included both a structured questionnaire and a clinical examination to assess sociodemographic variables, use of dental services, self-reported oral and general health as well as dental caries and number of teeth. For analysis, the participants were divided into three age groups: young adults (20–29 years), middle-aged adults (30–59 years), and senior adults (60 years and older). Differences among groups were analyzed by cross-tabulation, and logistic regression analyses were used to assess associations between variables.ResultsForty-eight percent of the participants rated their oral health as good. Almost half of the participants had at least one carious tooth, with the highest caries prevalence among the young adults. To be caries free was strongly associated with reporting good oral health among the young and middle-aged adults. One third of the senior adults had fewer than 20 teeth, which was associated with reporting moderate or poor oral health. Less than half of the young adults reported regular use of dental services, and 40% of them had postponed dental visits for financial reasons during the past 2 years. Regardless of age group, having to postpone dental visits for financial reasons or having poor-to-moderate general health were associated with high odds for reporting moderate or poor oral health.ConclusionsThat there were important age-group differences in self-reported and clinical measures of oral health and in the use of dental health services demonstrates the importance of age-stratified analyses in oral health research. Many adults, especially among the young, faced financial barriers for receiving dental health services, which was associated with poorer self-reported oral health. This argues for a need to revisit the financing of oral health care for adults in Norway.

BackgroundOral health inequalities are profound worldwide. Despite major improvements in oral health, inequalities exist for many racial and ethnic groups, by socioeconomic status, gender, age, and geographic location. Therefore, the purpose of this study was to investigate trends of socio-economic inequalities in access to oral health services in Peru before and after the implementation of Universal Health Assurance (AUS).MethodsAnalytical cross-sectional study based on the National Household Survey on Living Conditions and Poverty (ENAHO) 2004, 2008, 2010 and 2017. Two periods were defined before and after the AUS Law (2009). Use of oral health services was the dependent variable, for the general population and according to ages, the area of residence, and natural region. Measurements of inequality in the use of health services were made based on the concentration curves (CC), dominance test and concentration index (CI).ResultsWe included a number of 85,436 (2004), 88,673 (2008), 87,074 (2010) and 124,142 (2017) participants. The proportion of people who used oral health services was 8.4% (2014), 10.1% (2008), 10.6% (2010) and 10.4% (2017). Use of oral health services showed an increase in different age groups, urban and rural areas, and natural regions of residence during the study period. The CC were distributed below the line of equality, indicating an inequality of use of oral health services, in favor of the richest groups and dominance of the CC in 2017 over the previous years. Changes in the CI were statistically significant for < 5 years and in the rural area, and for the period 2010-2017 they were also significant in the general population, children aged 5-17 years, urban area, and Andean and Jungle regions, which indicates a reduction in the concentration of use of these services in these groups.ConclusionsThe use of oral health services in Peru increased and inequality decreased in the period 2004-2017, coinciding with the implementation of the AUS. However, the use of these services continue having a distribution in favor of the richest populations. It requires the introduction of new strategies and oral health programs in the Peruvian population, with the aim of closing the gap currently mediated by the economic possibilities.

To describe the prevalence and factors associated with the use of oral health services in people with and without disabilities in Brazil. A cross-sectional study was used with the secondary data of 60,202 individuals from the Brazilian National Health Survey of 2013. The main exposure variable was 'Disability', and the main outcome was 'Dental service use'. Independent variables were selected using the modified Andersen and Davidson model, according to four groups: exogenous variables, primary determinants of oral health, health behaviours and oral health conditions. The analysis was based on a hierarchical approach stratified by 'disability (yes/no)', with multiple logistic regression incorporating sampling design. Interaction terms between the disability variable and covariates were tested in logistic regression models. A total of 45.5% of the people without disabilities and 34.1% of those with disabilities visited the dentist in the last year. In the crude model, the nondisabled group used dental services more (OR=1.61, 95%CI=1.45-1.79), but the difference was no longer significant (OR=1.18, 95%CI=0.93-1.51) when adjusted by the health behaviour and oral health condition blocks. Determinants of dental use were similar among people with and without a disability. No difference in dental service use according to disability status was found after adjusting for oral health conditions. Although edentulism is more prevalent among disabled people, they do not go to the dentist as regularly as nondisabled people. Health services should actively schedule maintenance visits to ensure that the needs of disabled individuals are fully addressed.

The use of dental services is low among older adults, particularly among vulnerable or disadvantaged groups from various countries. Nonetheless, there is a gap in the literature regarding the factors that contribute to inequalities in the use of dental services. This study aimed to evaluate socioeconomic inequalities in recent and preventive use of dental services among older adults in Brazil and evaluate the factors contributing to these inequalities. This cross-sectional study used data from the 2019 Brazilian National Health Survey. The dependent variables were the use of recent and preventive dental services (among those who reported using dental services within one year prior to the interview). Socioeconomic status was measured by education level [no formal education vs. some education] and household per capita income [low (≤ 1 minimum wage [MW]) vs. higher (≥ 1MW)]. Explanatory variables included socioeconomic factors [education, household per capita income]; demographic characteristics [sex; age; living alone; rural residence]; general health status [limitations in basic activities of daily living (BADL); multimorbidity]; and oral health [use of prostheses; self-rated oral health; number of teeth; difficulty eating due to teeth or prostheses; dental insurance]. The Oaxaca-Blinder two-fold decomposition for binary outcomes was used to assess the factors contributing to educational and income-related inequalities in the use and preventive use of dental services. Participants with no formal education and those in the lowest income group had lower recent and preventive use of dental services. The number of teeth was the most significant contributing factor for the observed inequality, accounting for 30.6-51.8% of its increase across models. Difficulty eating made the second largest contribution to the explained inequality gap for preventive use and rural residence contributed to widening the gap for both outcomes. Socioeconomic inequalities in recent and preventive use of dental services among older adults are mainly explained by the number of remaining teeth, but other demographic, oral health, and health service factors play a role.

Differences in use of dental and medical services by noninstitutionalized children in Ohio

To ascertain the possible influence of sociodemographic variables on dental service utilization and oral health among Spanish children. This is a descriptive cross-sectional study using secondary individualized data drawn from 4,023 interviews conducted with parents or guardians of children aged 3-15 years as part of the 2001 Spanish National Health Survey. The dependent variables analyzed were use of dental services in the preceding 12 months, and caries ever. Classification of children was affirmative if their parents answered that the last time their child visited the dentist it was for a filling and/or had fillings in his/ her teeth/molars. Independent variables were sex, age, size of town or city, parents' educational level and monthly income of the family unit. A total of 47.1% of the study children had visited a dentist, stomatologist or dental hygienist in the preceding 12 months. Children having parents or guardians with the lowest educational level were 1.36 times (95% Cl: 1.10-1.68) more likely to have received no dental care than those having parents or guardians with the highest educational level. The likelihood of not having made use of such dental services rose 2.03-fold (95% CI: 1.58-2.61) in cases where monthly income was less than 900 euros versus greater than 1800 euros. Reported prevalence of caries for the sample as a whole was 31.45%. Children whose parents were in the lowest educational range were 1.37 times (95% CI: 1.08-1.71) more likely to have caries than those in the highest range. There is social inequality in the use of dental services and oral health among Spanish children.

The aim of this cross-sectional study was to evaluate the association between socioeconomic indicators and use of dental services in a sample of 3,048 Mexican schoolchildren. The dependent variable 'use of dental services' and independent variables were collected through a questionnaire addressed to mothers. To determine oral health needs, a clinical oral examination was performed. The adjusted associations were evaluated using polytomous logistic regression. Adjusted by gender, the categories associated with both preventive and curative services were age, greater frequency of brushing, earlier initiation of brushing, healthcare coverage, and better socioeconomic status. In addition, for preventive services only, use of services was associated with enrolment in private school, and for curative services only, family's possession of an automobile and having moderate to high oral health needs. The results suggest the existence of socioeconomic inequalities in the use of both preventive and curative dental services by Mexican children.

The present study aimed to evaluate if social, racial, and gender inequalities affect disproportionally the use of dental services by people with and without disabilities in Brazil. Dependent variable of the study was the use of oral health services. The outcome was stratified by gender, race, and social variables. Analysis using complex measures of inequality (Slope Index and Concentration Index of Inequality) was performed. Of 145,580 adults evaluated, 7.7% reported disability. The proportion of adults without disabilities who used dental services in the last 12 months was higher (45.4%; 95%CI 44.2–46.1) than adults with disabilities (33.9%; 95%CI 32.0-35.9). There was an absolute difference of 40 percentage points (SII − 0.40; CI95%(-0.45;-0.36) in the use of oral health services between poorer and richer people with disabilities. Absolute and relative inequalities were identified in the use of oral health services, considering the education of the head of the family and family income, with similar results for people with and without disabilities. High inequality is observed concerning race. Racial minorities (Black, Brown, Yellow, and Indigenous) without disabilities presented a higher use of dental services over 12 months than racial minorities with disabilities. Thus, social and racial inequities negatively affect individuals with and without disabilities.

Measure the prevalence of use of dental services in the previous year and associated factors among 31-year-old adults from a birth cohort of 1982. This is a cross-sectional study that analyzed a birth cohort of 1982 from the city of Pelotas. In 1997, a systematic sample of 27% of the city's census sectors was defined and all households in these sectors were visited, where 1,076 15-year-old adolescents were interviewed. For the oral health studies, 900 of these individuals were randomly selected and followed up at 24 and 31 years of age. The study used data collected from 523 individuals in 2013 (at 31 years old). The outcome was visit to the dentist (use of dental services) in the previous year. Demographic factors (sex), socioeconomic factors (income, education), and oral health factors (reason and type of service, self-perception of oral health, dental pain and caries experience - DMFT) were used as independent variables. Prevalence ratios were estimated using Poisson regression. The prevalence of use of dental services in the previous year was 55.3% (95%CI: 51.0-59.5%). In the adjusted analysis, the reason and type of service, self-perception of oral health, and DMFT were associated with the outcome. A stronger association was found with use of dental services in individuals who visited for prevention and used the private service, who were satisfied with their oral health, and who had more caries experiences. 55.3% of the cohort sample used dental services in the previous year. Individuals who visited the dentist of private service for preventive reasons, who were very satisfied with their oral health, used these services in a higher proportion. In addition, a higher DMFT index also led to higher use of services.

Between 2001 and 2002, all age limits restricting the availability of subsidized private dental care and Public Dental Services (PDS) were abolished in Finland. In addition, the reform aimed to address income- and residence-related disparities in access to subsidized oral health care services. The aim of this study was to analyse how dental attendance and factors associated with it changed after the reform. We carried out three consecutive surveys on the use of oral health care services and perceived oral health. The surveys were conducted in 2001 (n=2837), in 2004 (n=2420) and in 2007 (n=2296), and the study population comprised Finnish adults born in 1970 or earlier. Logistic regression analyses were used to examine factors associated with the use of the services. The percentage of respondents who attended dental care regularly or had used oral health care services over the past 12months rose between 2001 and 2007. In particular, there was an increase in the proportion of subjects who used PDS. The average number of visits to a private dentist decreased between 2001 and 2007. In the regression analyses, the use of services was associated with older age, perceived lack of need for care, perceived toothache during the past 12months, perceived good oral health, lower number of missing teeth and regular dental visiting habits. The use of private dental care services was associated with perceived good oral health and perceived lack of need for care, higher household income and older age in all three study years while the use of PDS was associated with younger age, perceived good oral health and perceived lack of need for care only in 2001. The use of oral health care services rose and age did not seem to be a barrier to the use of oral health care services after the reform, as was the aim of the reform. No change in the association of household income with the use of oral health care services was seen after the OHCR.

ObjectivesTo determine the prevalence and factors associated with the use of oral health services in Peruvian children under 12 years of age.Material and MethodsA secondary analysis of 2019 Demographic and Family Health Survey was conducted. The sample consisted of 40,751 children. The main variable was the use of dental services (attended/not attended) in the last 6 months, and the independent variables were gender, age, area of residence, wealth quintile, health insurance coverage, information received on oral health care, age, and educational level of the caregivers. Analyses of absolute and relative frequencies, differences in proportions, and multivariate analysis using generalized linear models were performed.ResultsThe dental service utilization prevalence during the last 6 months was 31%. Correlation was found with urban area residents (PRa = 0.945; 95% CI: 0.904–0.988), the Jungle geographical domain (PRa = 0.926; 95% CI: 0.877–0.977), the highest wealth quintile (PRa = 1.323; 95% CI: 1.232–1.421), the higher education level of the caregiver (PRa = 1.375; 95% CI: 1.231–1.536), affiliation with the Public Health Insurance (PRa = 1.112; 95% CI: 1.069–1.158), and the condition of having received information on oral health care (PRa = 2.355; 95% CI: 2.263–2.245) with respect to their baseline variables.ConclusionsSeveral socio‐demographic factors were correlated with the use of oral health services in Peruvian children under 12 years of age and the percentage of their use was low. Information on oral health care had a more significant impact on both, the population from the highest wealth quintile and the highest educational attainment.